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Curbs proposed on council powers over NHS reconfiguration

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The Department of Health has begun consultation on regulations that would significantly check local government’s power to refer controversial NHS reconfigurations to the health secretary.

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The plans would require local authorities to take into account the financial savings offered by service change as well as its impact on quality or patient access. Councils would also have to publish deadlines of when they would decide whether to make a referral.

They would also mean the decision to refer reconfiguration plans could not be delegated to health overview and scrutiny committees, but would have to be taken by full council meetings.

A DH consultation paper said referral to the health secretary represented “breakdown in the dialogue between local authorities and the NHS” and should be “regarded as a last resort”.

Requiring the decision to be made at full council meetings would “enhance the democratic legitimacy of any referral and assure the council that all attempts at local resolution have been exhausted”.

The paper said past evidence indicated that councils scrutinising reconfiguration plans interpreted the “best interests of local health services” in terms of the quality and accessibility of services.

Health scrutiny should also consider “opportunities the change offered to save money for use elsewhere in improving health services”, it added.

The Foundation Trust Network welcomed the suggestions, particularly on time limits and financial considerations. Noting a recent decision to place South London Healthcare Trust in administration, network chief executive Sue Slipman said “modernising” local scrutiny could “avoid the need to use a failure regime at all”.

But Tim Gilling, acting executive director of the Centre for Public Scrutiny, said there was a danger the proposed changes could shift the health scrutiny focus “entirely to finance”. He called for guidance on the best ways to balance finance, quality and safety.

Mr Gilling said referring decisions to full council meetings risked slowing down and further politicising the decision-making process. “Full council is, by its nature, a more political environment,” he said.

The consultation also floats the idea of introducing an “intermediate” stage, in which councils referred reconfigurations to the NHS Commissioning Board. They could only refer to the health secretary if they were unhappy with its response.

However, the paper admitted it might be “difficult” for the board to both help clinical commissioning groups to develop their reconfiguration proposals and review the same plans if asked to by a council.

An alternative approach, it suggested, would be for the board to play a more “informal role”, helping CCGs and councils to maintain a “constructive dialogue”.

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